Involve patient, family in care plan for elderly

Case managers often deal with crisis situation

By the time people come to case managers for geriatric care management, they already have dealt with the system and have a lot of frustrations and misinformation.

"Families usually turn to geriatric case managers when they are in crisis. Timeliness and responsiveness are very important," says Carole Stolte, RN, MA, CCM, CRC, CDMS, CPC, director of Maturity Concepts: Care Management & Consulting in Towson, MD.

Families who consult a case manager for long-term care planning often bring prior history and prior relationships to the table. As outside parties, case managers can take a look at the situation and present findings and recommendations, Stolte adds.

There is no ironclad solution for seniors. Their plans must be individualized.

The evaluation process and the case management process are a little different with elderly clients.

"Most case managers are coming from the acute care side of things. They are used to controlling what is going on when the patient is in an institution. When you deal with patients who are not in institutions, you need to be able to articulate information in such a way that you can help people understand which path would make most sense to them — not just clinically and financially, but emotionally and spiritually as well," says Elizabeth Bodie Gross, FNP, MBA, CCM, director of Lutheran Home Health Services in Arlington Heights, IL.

In long-term care planning, it is necessary for the patient and family members to be part of the decision-making process. Educating them about what is really going on is the key to moving things forward, she adds.

"When you’re making a long-term care plan, it’s very protracted. There’s a chronic condition, and you have to have patient buy-in. You can’t take it out of their hands," Gross says.

Don’t be surprised by resistance to change from your elderly clients, Stolte adds.

She often has suggested that an elderly person get involved with activities at a senior center and has met with total refusal. "The generation who are today’s seniors are very skeptical of reaching outside their own circle. They adapt to their isolation," she says.

Ask the family who has the ear of the parent. It may not necessarily be the older son. It may be the daughter who is a nurse.

"The seniors are much more likely to capitulate if a family member says, It’s important to me that you see a doctor,’" Stolte says.

When dealing with elderly clients, case managers first should develop a good relationship with the elderly and talk frankly with them about their options.

"If there isn’t good communication, plans will fall apart right and left," Gross says.